Human error has measurable monetary and safety consequences. To take one example, between 1992 and 2002, the National Aeronautics and Space Administration (“NASA”) experienced 10 major failures at an estimated cost of around $500,000,000 for which human error was the dominant contributor. This estimate includes only the financial cost of actual losses. This estimate does not include either non-financial losses, cost overruns or the cost of flight cancellations resulting from human error.
NASA is not unique in experiencing losses as a result of human error. Other portions of the public sector, including the military, other governmental entities, and the private sector experience substantial losses as a result of human error.
Generally, the most effective method to combat error is to identify where such errors may produce negative consequences and why such errors occur, and to try to eliminate the cause of the errors or mitigate their effects. Failure Mode and Effects Analysis (FMEA) was developed for the purpose of identifying potential hardware failures and “worst case” effects of these failures so that hardware failures could be eliminated or the negative consequences could be mitigated. Similarly, process Failure Modes and Effects Analysis (PFMEA) was developed to analyze each process in a system to identify possible procedural failures and “worst case” effects of each possible failure in order to eliminate or reduce the occurrence of such failures and/or to eliminate or mitigate the negative effects of the failures. To facilitate the identification and evaluation of human errors in PFMEAs, the Human Factors Process Failure Modes and Effects Analysis (HF PFMEA) was developed. HF PFMEA is a disciplined, systematic method to analyze each task in a process to identify potential human errors, the factors that contribute to the occurrence of the errors, the likelihood of the errors, the respective “worst case” effects of such errors, and the likelihood of the worst-case effects on a system. The methodology provides multiple aids that assist the analyst in identifying human errors for tasks (described by an action verb), factors that contribute to the likelihood that the error would occur, and a means to rank likelihood based on barriers and controls. In addition, the HF PFMEA identifies recommendations to avoid the occurrence of errors or to reduce any harm the errors may cause. HF PFMEA can be used at any phase in the system life cycle. In early concept design, the HF PFMEA facilitates design activities by identifying potential human errors, prior to system fabrication, so that designs may be modified to eliminate the errors or mitigate their effects. Later in the system life cycle, when the system is in operation, HF PFMEA improves project safety by providing a capability to analyze human factors issues including health and safety risks and generate recommendations for process improvement. HF PFMEA facilitates design of activities, systems and environments to enhance the abilities of personnel involved in a process and accommodate the limitations of personnel to produce safe, productive and comfortable use of a system.
Even though the potential benefits of HF PFMEA are tremendous, the method is not used as often as it could be because performing HF PFMEA involves a time-consuming and labor-intensive manual process by one or more persons trained in HF PFMEA. The HF PFMEA methodology includes functional analysis, task analysis, root cause analysis, work methods analysis, risk assessment, human error identification, human error analysis, and other techniques. Once the analysis is complete, it must be documented in the HF PFMEA table: An analyst builds HF PFMEA tables to present most of the analysis data resulting from the manual HF PFMEA process. Because extensive knowledge in human error analysis is required and a large volume of data must be incorporated into the HF PFMEA tables, creation of these tables is very time-consuming. As a result, existing HF PFMEA methodologies are expensive, time-consuming, and require extensive training. These issues unfortunately represent barriers preventing more widespread and more extensive use of HF PFMEA methodologies.
Thus, there is an unmet need in the art for facilitating HF PFMEA and thereby allowing for faster, less costly ways to implement plans to evaluate and control human error throughout the system life cycle in order to reduce risk and improve process efficiency.